Ovarian function following use of various hemostatic techniques during treatment for unilateral endometrioma: A randomized controlled trial

Abstract

Objective To compare the effect of hemostatic techniques (bipolar energy versus hemostatic sealants versus suture) on the ovarian reserve of patients submitted to laparoscopic cystectomy for the surgical excision of unilateral endometrioma. Methods A randomized controlled trial conducted in a teaching hospital included 84 patients with unilateral endometrioma. The patients underwent laparoscopic stripping for excision of the unilateral endometrioma between March 2018 and February 2020. Three different hemostatic techniques—bipolar energy (Group 1), hemostatic sealants (Group 2), and suture (Group 3)—were compared. Anti‐Müllerian hormone (AMH) levels were measured before, and 1 and 6 months after surgery to determine changes in ovarian function. Results Following surgery, AMH levels decreased in all the groups; however, this decrease was not statistically significant. Comparison between groups showed no statistically significant differences in AMH levels between the three hemostatic techniques used. Six months after surgery, median AMH levels were: 1.65 ng/mL (interquartile range [IQR] 0.62–2.08 ng/mL) in Group 1, 1.87 ng/mL (IQR 1.27–2.97 ng/mL) in Group 2, and 1.53 ng/mL (IQR 1.18–2.44 ng/mL) in Group 3. Conclusion The present study suggests that there is no difference between the different hemostatic techniques used in laparoscopic cystectomy for the treatment of unilateral endometriomas. Registered at ClinicalTrials.gov: NCT03430609. https://clinicaltrials.gov/ct2/show/NCT03430609

Endometriosis-associated infertility: From pathophysiology to tailored treatment

“…Lower rates of spontaneous pregnancy and higher rates of recurrence are associated with ablative surgery compared with cystectomy, whereas cystectomy was found to be deleterious for residual ovarian function (162,379,380). Since the meta-analysis of Dan et al in 2013 (380), RCTs comparing ablative versus excisional techniques in terms of ovarian reserve markers and ovarian residual volume have been performed (381)(382)(383)(384)(385)(386). Data from animal studies (387) and RCT (381,382,388) on the use of laser and plasma energy is encouraging and may result in less inadvertent tissue removal and thermal injury compared with cystectomy and bipolar electrosurgery.…”

“…Since the meta-analysis of Dan et al. in 2013 ( 380 ), RCTs comparing ablative versus excisional techniques in terms of ovarian reserve markers and ovarian residual volume have been performed ( 381 – 386 ). Data from animal studies ( 387 ) and RCT ( 381 , 382 , 388 ) on the use of laser and plasma energy is encouraging and may result in less inadvertent tissue removal and thermal injury compared with cystectomy and bipolar electrosurgery.…”

An overview and comprehensive analysis of interdisciplinary clinical research in endometriosis based on trial registry

“… 31 In contrast, twelve publications were identified from classic trials started after 2018, mainly involving gonadotropin-releasing hormone receptor antagonists, 32 , 33 pre- in vitro fertilization (IVF) medication, 34 surgery, and ovarian function preservation. 35 …”

Efficacy of ablation and sclerotherapy for the management of ovarian endometrioma: A narrative review

“…However, two studies reported significantly smaller serum AMH decrements in the suturing group [ 20 , 21 ]. Among the six studies comparing bipolar coagulation versus hemostatic agent, the serum AMH decrements were similar in three studies [ 22 , 23 , 24 ]. However, three studies reported significantly smaller serum AMH decrements in the hemostatic agent group [ 16 , 25 , 26 ].…”

“…Interestingly, Araujo et al [ 24 ] compared serum AMH decrements after all three methods (bipolar coagulation versus suturing versus a hemostatic agent), but the serum AMH decrements were similar in all groups. These 11 studies showed varying results for the results of the serum AMH decrement; therefore, no conclusions can be drawn.…”